15 Charged in US over Alleged $2 Billion Medicare and Insurance Fraud Schemes; Eight Arrested
Federal prosecutors in the United States have charged 15 people in connection with alleged Medicare and insurance fraud schemes. The Justice Department said on Thursday that the alleged schemes, spread across multiple states, collectively took in about $2 billion.
Eight of the defendants were arrested by federal agents on Thursday. According to officials, most of the arrests took place in California. Some of the defendants are physicians, it was stated.
According to the allegations, the methods of fraud varied from case to case. In some, private insurers were billed for phony substance abuse treatment; in others, Medicare was billed for unnecessary atherectomy procedures. An atherectomy is a procedure to remove plaque from blood vessels.
Another set of allegations says Medicare was billed for hospice services for patients who were not terminally ill. Hospice care is meant for people in the final stage of life. The allegations say bills were submitted without that condition being met.
The Justice Department said five of the suspects were expected to appear in federal court in Los Angeles on Thursday afternoon. Two others were expected to appear in federal court in Texas and another in federal court in Illinois. Attorney information for the suspects was not immediately available.
The biggest case focuses on two people in Los Angeles and another in Texas. It is alleged that for years they moved substance abuse patients from around the country to California.
The group allegedly enrolled the patients in insurance policies they were not eligible for and obtained the highest reimbursement for substance abuse treatments. According to the Justice Department, they received over $1.6 billion in this way.
In a separate case, a Los Angeles cardiothoracic surgeon and a chiropractor have been accused. They allegedly falsely diagnosed patients with arterial disease and recommended that they receive atherectomies.
The suspects in that case billed Medicare for over $135 million for the procedures, the Justice Department said. Unnecessary medical procedures can also be risky for patients' bodies, which is why such allegations are treated seriously.
Three other cases deal with hospice fraud. According to the Justice Department, the suspects in those cases billed Medicare a combined $138 million. The allegations say the bills were submitted in the names of patients who were not terminally ill.
Taken together, the alleged amounts reach about $2 billion. Fraud in the US health insurance system is a longstanding problem, and federal authorities periodically bring cases against such networks through large operations. These charges are part of that pattern.
The cases will now go through the court process. If the charges against the defendants are proven, they will face punishment. Until the trials conclude, however, these remain allegations, and any finding of guilt will depend on the courts' decisions.
